Part 3 – Practice Key Performance Indicators – CLINICAL

By Chandresh J. Shah


Clinical Practice Key Performance Indicators –  Part-3

Growing a practice can take a lot of work and having goals can help. That is why it is important to have KPIs (Key Performance Indicators) that can be used to determine how well practice goals are being met.

Let me share to you KPIs that will help your practice on 4 main areas:

  1. Front Desk
  2. Clinical
  3. Billing and Revenue Cycle Management
  4. Reputation Management

This week – Clinical KPI’s. These KPIs are:

  1. Patient Care Hours
  2. Number of Patient Referrals
  3. Patient Transactions
  4. Patient Confidentiality
  5. Patient Follow-up
  6. Rate of Complications
  7. Patient Adherence to Treatment plans.
  8. Communication between primary care, specialists and patients.

In the video below, I went through and explained what each Clinical KPI You can also download the guide through this link (Click Here):

You can also watch the first two KPI Videos.

1. Front Desk KPIs.

2. Billing KPIs.

Part 2 – Practice Key Performance Indicators – BILLING AND RCM

By Chandresh J. Shah

Growing a practice can take a lot of work and having goals can help. That is why it is important to have KPIs(Key Performance Indicators) that can be used to determine how well practice goals are being met.

Let me share to you KPIs that will help your practice on 4 main areas:

  1. Front Desk 
  2. Clinical
  3. Billing and Revenue Cycle Management
  4. Reputation Management

Let me begin with KPI’s for Billing and Revenue Cycle Management as they are the first point of contact and impression your practice makes with existing and new patients. These KPIs are:

14. Net Collections Rate

15. Total Operating Margin

16. Average Insurance Claim Processing time & cost

17. Average cost per patient

18. Claims Rejection rate

19. Average insurance claim processing time and cost

20. Average Treatment Charge

21. Percentage of Patients without Medical Insurance

22. Time Gap between Date of Service and Date Billed

23. Percentage of Claims Denied overall, and by Payer

24. Percentage of Claims Denied due to Front-end errors vs Coding oversights

25. Percentage of Patients with Public vs Private Insurance

26. Percentage of No-Response claims overall, by Payer

In the video below, I went through and explained what each KPI meant for the Billing and RCM. You can also download the guide through this link (Click Here):

Practice Key Performance Indicators – Front Desk

By Chandresh J. Shah

Growing a practice can take a lot of work and having goals can help. That is why it is important to have KPIs (Key Performance Indicators) that can be used to determine how well practice goals are being met.

Let me share to you KPIs that will help your practice on 4 main areas:

  1. Front Desk 
  2. Clinical
  3. Billing and Revenue Cycle Management
  4. Reputation Management

Let me begin with KPI’s for Front Desk as they are the first point of contact and impression your practice makes with existing and new patients. These KPIs are:

  1. Patient In-Office Wait Time
  2. Schedule Density
  3. Percentage of Electronic Health Records
  4. Confirmation and No-Show Rates
  5. Patient Phone Wait Times
  6. Check-In Efficiency
  7. Number of Patients Served Per Month
  8. Number of New Patients Served Per Month
  9. Number of Patient Referrals
  10. Staff Time Spent Entering Data/Charting
  11. Doctor-Care-to-Paperwork Ratio
  12. Percentage of Patients Who Found Paperwork to be Clear and Easy to Understand
  13. Patient Care Automation (i.e. paper work required)

Watch this “Top 40 KPI” video as I went through and explained what each KPI meant for the front desk. You can also download the guide through this link (Click Here):

Your practice is not just a routine business – You need Entrepreneur Employees

By Chandresh J. Shah

A medical practice may seem like a ‘routine’ business. However how many times have you said – “My practice is different from others”’? It is because every business owner and founder has a vision that you believe should set apart your practice from others. There is a reason why you are independent and don’t join a large hospital. It is this vision that must be articulated and passed on.

In a practice, we encounter different kinds of employees. Of course, we would want to have employees worth keeping. What characteristics of employees should you look out for? If your practice has employees that have these characteristics, consider yourselves lucky:

(They) Hustle but they are able to estimate the right amount of push you and others need.

Why are these characteristics a winning combination for a practice? It is because employees with these characteristics are Entrepreneurs.

Good Employee vs. Entrepreneurial Employee

The Good Employee

Most employees qualify as ‘good’ because they do their tasks well; tasks that fit into the overall vision of the founder/provider/owner. They hone in well on their particular function. These people are essential to making a business work well.

But these are not the kind of people suited to take over the entire operation. Many employees have a title that suggest they are senior and therefore are leader. That is not necessarily true.

For Doctors and providers running and managing their own practice hiring an entrepreneurial employees can be risky. That is because employees with characteristics listed above can be unwieldy and intimidating. They can and will exert their dynamic pace of action and thought.

The Entrepreneurial Employee

How do you identify these entrepreneurial employees?

They have tremendous energy. Not just during the first few months of hiring, but always – like an energizer battery. They not only work hard, they hustle. They impress with intensity.

Commitment to personal improvement. You may find them reading self-improvement books, taking evening or online courses, subscribing to personal improvement blogs. It is ambition that drives them but not just for pure ambition of climbing ladders, but personal improvement. This can lead to benefits that the practice will gain from.

They don’t like being micromanaged. Entrepreneurial employees should be ‘handled with care’. You – the practice leader – can encourage or inhibit entrepreneurial behavior. If you manage employees too closely (micromanage), creativity and entrepreneurial behavior will be stifled. Conversely, they will flourish. Entrepreneurs need space to think and create. Remove boundaries and perceived limits.

They share their plans and ideas proactively. Don’t consider this as someone trying to get close to you and impress you. They may have ideas about growing the practice, increasing patient satisfaction, increasing online reviews, increasing patient collections, and overall practice efficiency.

They want to get things done – not just talk about it. Entrepreneurs are doers and thinkers. Their thinking is done not just when you ask them but it is done way in advance. They want to act on those ideas. Many entrepreneurial employees get fidgety in meetings, get impatient because they want action not just talk in meetings.

They may threaten to leave if they are not thriving. This is the downside of hiring entrepreneurial employees. They want to see growth and success and be instrumental in making it happen. It is up to you to create an environment where they thrive. Share your vision and work to have them make it their own. If there is a disconnect, this employee is perhaps not a good fit.

They may not be excellent team players. Sometimes, the most entrepreneurial employees don’t work well on teams. They don’t think like other people, and may have trouble understanding or empathizing with alternate points of view. These are not bad team members, their entrepreneurship needs to be harnessed.

Working with an entrepreneurial employee

I was helping a good friend and client several years ago. His practice was struggling to grow. He had just lost a provider/partner. One of his employees did not have the ‘office manager’ title, but she acted and behaved like one. She was a hard charger and driver. She intimidated everyone, but at the same time, other employees respected her for her knowledge and tenacity. They implemented a new EHR. She learnt and mastered it to the point where she became the internal ‘guru’. Even billing staff reached out to her.

The owner provider was concerned and scared. He was contemplating letting her go because even he felt intimidated. We talked it over and established a 6 month plan. We gave her a vision for personal and practice growth, and linked them together. We established boundary conditions and left her alone without micromanaging. We met with other staff members and sought out their feedback and articulated her role.

After 6 years, she is the office manager – she’s happy and the practice has grown tremendously.

Recognize and seek out entrepreneurial employees, you will not regret it.

Let me know if I can help. Pick a time on my calendar to discuss ideas. (Give it a few seconds for calendar to load after you click)

An interesting way to avoid medical litigation

By Chandresh J. Shah

I’m sure you all have heard about the term word-of-mouth marketing.

Getting people to talk often, favorably, to the right people in the right way about you and your practice is far and away the most important thing you can do for your practice. This is the essence of word-of-mouth marketing.

As the topic interested me, I have been reading a book – Talk Triggers, by Jay Baer and Daniel Lemin.

There is a very interesting case study. He mentions Dr. Glenn Gorab, an oral surgeon in Clifton New Jersey. Dr. Gorab started doing something more than 15 years ago. He created a differentiator that other providers don’t seem to copy or follow despite its success as a word-of-mouth generator.

In the book, Dr. Gorab says, ‘I’ve actually mentioned this approach to several of my referring dentists, and none of them implemented it,”.

Dr. Gorab’s approach

Every weekend Dr. Gorab calls each patient that is coming to the office for the 1st time the following week. His typical greeting is as follows: “Hi, this is Dr. Gorab, I know we have an upcoming appointment for you next week, I just wanted to call to introduce myself and ask if you have any questions prior to your appointment.”

Dr. Gorab says patients aren’t really sure what to make of the calls because they are so unexpected. “Most people are shocked that a doctor would call them prior to their appointment; they are almost dumbfounded. It’s so out of the ordinary. They say: no one has ever done this to me before.”

These patients tell their friends about Dr. Gorab’s calls, and they deliver new patients through his front door on a consistent basis.

He says 80% of patients mentioned the calls once in the office for their appointments.

Quite literally, every physician-every professional service provider, could mimic it, yet they do not. Why?

An interesting side benefit. Medicine is incredibly litigious in the United States and has been for decades. 99% of high risk surgical specialists will face a patient lawsuit during their career. Oral surgeons are similarly at risk for legal proceedings, but Dr. Gorab has avoided them entirely across his 32 year career.

“I have never been sued for anything,” he says.” And I do surgeries; I do surgery every day. I have complications. Some of them have been at complications. But probably the reason why I haven’t been sued is because people understand that I care about them, and people don’t sue people they like. The fact that I care about people is the biggest determinant of that, and the fact that I call them ahead of time means that I’m taking an interest in them and I care about them. So right from the start, they see that I care about them.”

Are you ready to try this approach?

Patient data from EHR vendors found for sale online

By Chandresh J. Shah

(Becker’s Health IT and CIO Report)

I read above article this morning and it shocked me.

What shocked me more is that a couple of EHR vendors mentioned in the article are very well known.

It bothered me that these cloud vendors’ data was leaking. So I read further.

There is good and bad news. The good news is that the vendors are not involved in the leak at all. The bad news is that it is up to the individual user to protect how they use cloud systems.

The data going from the browser of your computer to the vendor servers is completely encrypted. In other words, a packet of stuff leaving your office to another destination is protected by a bulletproof case. But what if somebody entered your office and stole stuff before you put it into the bulletproof case?

That is what seems to be happening here. We may unknowingly install a lot of third-party browser extensions and add-ons without knowing what they are capable of doing. These are the hidden spies and thieves lurking in your computer browsers. These rogue extensions collect information about where you serve and what you view and do online. The clicks are then harvested for marketers and data brokers.


Without going into the technical details I would advise that you use the browser without any extensions installed. If you have to install extensions, please seek the advice of a trusted IT advisor if you wanted to make sure the extensions are safe. Protecting your patient data should be priority and can be done each user continues to be mindful on what should be done to protect it..

How to Avoid and Manage No-shows

By Chandresh Shah

Everyone talks about patient no-shows. Some practices take for charge and control, some, not so much. I’m dividing the nemesis of no-shows into parts. One, how to avoid them in the first place and also, how to manage them because inevitably you cannot ever eliminate them.

Good scheduling practices are financially more rewarding.

We have to start by analyzing, understanding and empathizing with the reasons why there are no-shows to begin with. They can range from forgetfulness, financial issues, to lack of transportation.

Avoiding No-Shows

  1. Chronic Culprits: Patients miss appointments from time to time which is understandable but you need to identify chronic appointment ‘Missers’. Restrict them to same day or one day in advance.
  2. Same day openings: Try to keep few appointments for same day if your patient backlog permits.
  3. Double book: Double book chronic culprits so that you don’t end up with empty slots.
  4. Appointment reminders: Phone reminders and SMS are good but add manual reminders for some patients – chronic, high value etc. One size does not fit all.
  5. Keep waiting time to minimum.
  6. Thank patients who keep appointments and arrive on time.
  7. Provide printed copy for next appointments – even if you send emails and automated messages.
  8. Ask about transportation if you know some patients have issues.
  9. Staff education and prioritization. Create a policy to address scheduling needs and all staff must be on same page.


  1. Keep wait list
  2. Follow-up no show immediately – don’t wait.
  3. Manage ‘late comers’. Counsel, and warn them as necessary. Enforce a small penalty after repeated warnings.
  4. Have a written policy that is clear, implementable.
  5. Have a clear no-show fee. You can try the approach of taking it off on next on time appointment.

Let me know your thoughts and if you have something to share.

Modify the EHR to fit your current workflow or adjust workflow according to the EHR system. What should you do?

By Chandresh Shah

Wrong question. It is like putting a cart before the horse.

In the past few weeks, I have talked a lot about practice revenue and revenue cycle management. Let me focus on that as I try to explain what I mean.

Examine some possible problems or ‘current state of affairs’.

Example 1

Overall collections are not bad, but there are two issues that can be improved:

o Patient collections down

o Few Denials too many!

The billing department (in-house or outsourced) is doing a good job. The over-90-day accounts receivables is within industry norms, they work very diligently to pursue all claims and every last dollar. They are doing everything they can, within their power.

The problem is, there are things that can be done better upfront – before the patient comes in, before the claims go through. How?

  • Getting pre-cert done for procedures before-hand.
  • Getting eligibility for special type of visits before patients walk in so that you are not caught with pants down.
  • Full knowledge of Patient co-pays, out of pockets and balance remaining on deductibles, before patient comes in for a visit.


Examine your practice workflow with respect to these specific problems.

  • How/Who can check eligibility and other insurance details before patient visits?
  • How/Who can check insurance details, outstanding patient balances, pre-certs, authorizations?
  • Once checked, what should be done to take care of and/or avoid downstream problems?

Example 2

Your practice receives a paper EOB and check for 10 claims. You receive this check on 1st of the month. Someone enters payment into your billing software and deposits the check into the bank. The person in charge of payment posting is not able to post the payment until after 2 weeks, say 15th of the month, for whatever reason.


The Billing Manager runs the ‘payment’ report where there is a discrepancy.

She wants the report to reflect Payment Posted date to match the date when the check was received.

Read the above sentence again. Do you see anything wrong with this?

First of all, every activity in any system should reflect the date when that activity is performed. If the software reflects the date of payment posting on a claim as May 1 instead of May 15, that is exactly what it is.

So, why does the billing manager want the payment posted date as the date on check? If the reason is to be able to accurately reconcile the claims payment date, then the payment posting process needs re-examination, not the technology or software!

Therefore, the answer is to link workflow and processes to Problems and Solutions rather than technology.


Practices are too close to the problem to realize that the process is broken, or can be improved, because it is based on assumptions and conditions that were established a while ago. Environments – business and technology – change, which requires adaptability to change processes.

Successfully solving problems requires partnership and information sharing. It is a result of two or more people sharing the workload and committing to same outcome.

If you see your vendor as a vendor that is simply making and peddling software, you’re on your own. If you see your vendor as a partner allow them to help you, they have a lot of experience and you don’t have to pay ‘consulting’ fees to more expensive health IT consultants.

A vendor that says yes to everything you want should be approached with caution. Is the vendor challenging you to think of your current state and encouraging you to visualize a better future state? If yes, proceed.

Dr. Google – Converting a threat to Opportunity

By Chandresh Shah

We have heard stories or have firsthand knowledge of how patients come to see physicians armed with printouts and information gleaned from the Internet about conditions that they are experiencing.

It almost seems like patients visit Dr. Google first before they come to see their physician. You probably have experienced times that when they come to your office, some already have a diagnosis in mind.

According to a study in 1999, it was found that health-related concerns dominated much of what people were looking for on the Internet. People are finding it easier to search online for answers to their health related questions. They seem to be bypassing traditional medical sources.

This creates a dilemma when patients walk in armed with information from “Google”. People fail to understand that Google is just a search engine and not a database of health-related information. There are instances where even if these patients are unable to determine the trustworthiness of the sources of information, they would still take the information hook, line and “clicker”

Dealing with Dr. Google

When dealing with a patient equipped with a “diagnosis” from Google, the obvious question is, how do you win a patients trust and resolve conflicts if a patient wants tests and treatments that you believe are unnecessary?

There can be many creative ways in which physicians can tackle this issue [I’m not calling it a problem].

The 1st goal is to Acknowledge that people go to the Internet because they have a problem, and the Internet is available and accessible easily.

2nd is to Understand and Acknowledge that patients are sometimes confused with the abundance of medical information available online.

You know very well and believe that Internet can never come close to the physician. It is not about competing with the Internet. We must accept Internet as a tool, not as a replacement.

Acknowledging can go a long way as it can help promote more open communication. As with any patient exam, you must always start by acknowledging the patient’s concerns. This is what we call as active listening even when you think you know exactly what the patient is going to say.

A large percentage of patients see their physicians with ideas they may have acquired from the Internet, which may or may not prove valid. But such research can bring out emotions and concerns related to their health symptoms, such as fear, uncertainty, sadness and worry. Being attentive to these underlying emotions, recognizing the patient’s perspective and allowing the patient to feel respected and heard goes a long way in developing mutual trust.

It is this trust that has the best chance of converting the challenges presented by Dr. Google into opportunities. This is the new evolution of physician-patient partnership that overcomes the threat posed by patients conducting their own research online. Instead of resisting and resenting the fact that patients conduct their own research online, it is better for physicians to be patient and understand the reasons why patients do this.

Dr. Google-From Threat to Opportunity

Knowledge empowers patients in shared decision-making. When providers realize that patients have received misinformation, or biased medical suggestions and come into the office with preconceived ideas about their diagnosis or treatment, it is precisely the trust that allows providers to overcome those fears.

It must also be realized that many patients come to see the doctor based on their online research which convinces them that they need medical attention and need to see a medical professional. It should be seen as a positive patient engagement rather than negative. Patients who have done online research seem to be more attuned to his or her symptoms and they can articulate them more easily.

In summary, changing the mindset from Internet being a threat to an opportunity not only develops the trust but can also lead to better patient outcomes as it can encourage better patient compliance with treatment plans because patients are now part of the solution.

Delegating too much can become a problem

By Chandresh Shah
I have written about leadership and delegation in the past, but I just realized that sometimes, over delegating can become a problem.

As a physician, you focus on patients and managing your practice. You work on projects and initiatives that need your attention. Working on tasks that do not add a lot of value, will quickly make you overwhelmed and stressed.

Most of you realize that delegation in some form is extremely important. Too much of anything is not good though. You need to make sure is that you do not delegate too much as that can lead to delegating the wrong things.

In this article, I’m not going to talk about why some people do not delegate. (It could be either they don’t trust others, they don’t trust that others will be able to handle certain tasks according to their standards and they would have to redo those tasks. I have also discussed this on a my previous article). I will , on this article focus on



What is over delegation? Over-delegation means:

· Delegating everything.

· Delegating way too much

· Delegating to the wrong people

· Delegating the wrong tasks

Here are some examples of what I have observed while working with clients:


A solo provider in his private practice has a very respected position in his area. He loved talking to patients and taking care of them. Beyond that, he pushed everything else to others. He said he had a very capable office manager. A couple of months ago, he called me in panic saying that some good staff members were leaving and his billing collections was falling behind. He was at a loss to explain the reasons. He also commented that perhaps he had the wrong person in charge of office management all along.

His office manager was actually a very capable person.

Looking at what happened , here is what I found out- the most important issue was lack of clear and frequent communication, not only with his office manager but also the administrative and clinical staff. The provider, who thought that he should “delegate” simply told them what he wanted, and assumed they understood and would get it done. He did not consider the implication of the kind of delegation he is doing where he is resigning responsibility and authority to his staff. In effect, when things go wrong, the physician got upset. This is what happens when you delegate too much.

Delegation is not an art; it is a skill that must be learned.

It is important to know what to delegate, who to delegate and how much to delegate. But behind all this, is the importance of proper guidelines and communication tied to tasks you carefully chose to delegate. You also need to clearly communicate expectations and methods of reporting.

It is amazing how many physician owners do not know the details of their revenue cycle management. Providers should know and proper communication on this delegated task will get the provider information relevant to him.

In summary, Delegation does not mean simply giving orders and handing off tasks and projects with the assumption that you will get the results you desire.

Ultimately, you are still responsible to ensure and close the communication loop. You must establish key performance indicators or metrics for measurement of success. Communication is one thing that you cannot delegate. Otherwise you will set yourself and others up for a lot of frustration and problems.